Don’t forget additional code.
You’ve had it pretty easy up until now — reporting a malignant tonsil with just one code: 146.0 (Malignant neoplasm of tonsil).
You can forget about easy when ICD-10 goes into effect October 1 this year, because you’ll need to select from four malignant tonsil codes, plus choose a code from a host of additional codes that you must report secondarily.
Learn the Choices:
ICD-9 specifies that 146.0 is for tonsil, faucial, palatine, or not otherwise specified (NOS), and directs you to different codes for lingual or pharyngeal tonsil.
ICD-10 makes the same distinctions — and then some. Instead of one code for the palatine tonsils, you have the following choices:
Question: One of our physicians was called and asked to do a consult on an inpatient. This patient was being treated in a rehab facility but was mobile enough to come to our office to be seen. The physician billed a new patient visit of 99203 along with 69210 for removal of impacted cerumen. This was denied by Medicare for “Not being paid separately when patient is an inpatient.” Should I have still submitted a consult code even though she was seen in the office? How should this be billed in the future?
Downcoding errors mean that these providers are selling themselves short.
When you hear that a MAC reviewed a practice’s documentation and found errors, you probably assume that the payer uncovered dozens of upcoded charges. But in some cases, the opposite may be also true. That’s the case with a recent CERT audit summary reported by Part B MAC WPS Medicare, which found a variety of errors including several cases where the practices could have billed higher E/M codes.
Downcoding Is Alive and Well
WPS Medicare recently released its Fourth Quarter 2014 CERT Error Summary, which reveals the documentation, coding and billing errors that the contractor uncovered during its most recent audit. Most of the errors were related to insufficient documentation, including situations where the physician signature or order was missing from a claim, as well as missing progress notes and dates of service.
Confirm if any ultrasound guidance was used.
Remember how three new codes joined revised codes in the family of ultrasound guided arthrocentesis of small, intermediate, and large joints in January? The previously existing codes, 20600, 20605 and 20610, now include the phrase “without ultrasound guidance” and each is partnered with a new code (20604, 20606, and 20611) with the descriptor, “with ultrasound guidance, with permanent recording and reporting.” The changes are as follows:
- 20600 – Revised (Arthrocentesis, aspiration and/or injection, small joint or bursa [e.g., fingers, toes]; without ultrasound guidance)
- 20604 – Code added (with ultrasound guidance, with permanent recording and reporting)
- 20605 –
The May 2015 CPT® Assistant features the newly established Category III leadless cardiac pacemaker codes. The issue elucidates guidelines and provides real-world clinical examples that assist you to appropriately report the codes for leadless cardiac pacemaker services.
Another topic in the May 2015 CPT® Assistant will help a wide range of providers as it covers proper application of the code changes in 2015 for the vaccines and toxoids section. Plus, reviewing the latest issue will boost your coding skills for reporting carotid artery and innominate artery stent placement as well as bilateral image-guided breast biopsy and marker placement. Take advantage of SuperCoder.com’sCode Connect code and keyword search to keep your skills up to date on these topics:
- Bilateral Image-Guided Breast Biopsy and Marker Placement: 19081-19086, 19281-19286
- Pacemaker, Leadless and Pocketless System: 33202, 33203, 33206-33222, 33224-33226, 75820, 76000, 93566, 0378T-0391T
- Stent Placement in Carotid Artery and Innominate Artery: 37217-37218, 36221-36222, 37236
- Vaccines and Toxoids Code Changes in 2015: 90460-90474, 90476-90749, 90630, 90651, 90654, 90721-90723, 90734.
Code choices will hinge on presence of hypercapnia or hypoxia.
Treating patients who have chronic conditions can change how an anesthesiologist provides care in some circumstances, and might even allow for additional reimbursement. One example is a patient undergoing a procedure who has been diagnosed with acute exacerbation of chronic respiratory failure.
ICD-9: Currently, providers have three diagnosis choices in this situation, depending on the presence of hypercapnia or hypoxia from the results of blood gas analysis (which you’ll need to acquire from the surgeon or other physician).
For acute exacerbation of chronic respiratory failure, you report 518.84 (Acute and chronic respiratory failure).
Question: Our physician injected multiple branches of the genicular nerve (superior lateral, superior medial, and inferior medial). Do we report 64450 once, or bill it three times with modifier 51? Also, what would be the correct code for thermal radiofrequency ablation of this nerve?
Expect more comprehensive audits instead of desk reviews.
The HHS Office for Civil Rights has announced that it is yet again delaying Phase 2 of the HIPAA audits — with no definitive date set for the audits to actually begin. When the audits do start, however, they’ll be much more intense than previously planned. Here’s what you need to know to prepare.
Why the delay? “Phase 2 of the HIPAA audits was initially slated to begin in the fall of 2014 and was subsequently moved to late 2014 or early 2015,” noted Charlotte, N.C.-based attorney Chara O’Neale in a blog post for law firm Parker Poe. “Currently, no timeline has been provided as to when the next round of audits will officially begin.”
Decision also means ICD-10 will move forward this year.
Unfortunately, it was no April Fool’s joke that April 1 came and went with no final Congressional action to override the 21 percent Medicare pay cut.
Although the House passed the Medicare Access and CHIP Reauthorization Act (MACRA), the Senate failed to vote on the bill before departing for a two-week recess on March 27.
“Their failure to act leaves physicians facing a devastating 21 percent cut in Medicare reimbursements when the current Sustainable Growth Rate (SGR) payment patch expires on March 31,” said Robert M. Wah, MD, president of the AMA, in a March 27 statement.
The April 2015 CPT® Assistant ends your confusion about new drug identification and testing codes updated in the 2015 CPT® code set. Find out how the new reporting mechanism distinguishes testing procedures based on presumptive, definitive, and therapeutic drug assay categories instead of the old qualitative or quantitative methodology.
Reviewing the latest issue will also improve your understanding of how to report optical coherence tomography of the breast and total disc arthroplasty. Plus, solve an ICD-10-CM coding dilemma with an immunization coding scenario. To get spot-on guidance, simply type a code or keyword into SuperCoder.com’sCode Connect to see the April article that suits your needs.
- Drug Identification and Testing: 80100-80104, 80150-80299, 80320-80377, 82491-82492, 82541-82544, 83992
- ICD-10-CM Case Scenario: 90460-90461, 90471-90474, 90654, G0008
- Optical Coherence Tomography During Breast Surgery: 0351T-0354T
- Sacroplasty: 22511, 0200T, 0201T
- Total Disc Arthroplasty: 22554, 22845, 22851, 22856, 22858, 63075, 0375T, 0092T.
The latest selection of CPT® Assistant FAQs also provides guidance for a variety of areas. Find authoritative answers in a snap by looking for these codes and topics on Code Connect: